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Rancho Codova, California | Contract To Hire
Responds to and resolves various customer inquiries via telephone and correspondence, and resolves claims problems within established production and quality standards. Answers incoming calls and written requests for information from members or providers promptly and accurately. Composes routine and non-routine correspondence to answer member inquiries that require a written response. Coordinates with other departments to ensure timely and appropriate responses. Expedites and resolves complex issues and makes claim adjustments. Educates others on the Blue Shield product, providing accurate information and updates to policies and procedures, improving overall customer satisfaction in the process. In the Lead role, deals with the most complex cases and issues as an individual contributor or may focus on mentoring and acting as a backup for supervisory responsibilities. May assist in scheduling and coordinating team activities. Typically provides input in hiring decisions and performance appraisals. Handles the highest level of escalated and unresolved calls.
Successfully exceed Associate level responsibilities. In addition,
Successfully completes tier 2 training which covers some of the following: Handles escalated calls; may de-escalate calls Responds to member benefits in writing Peer to peer coaching /training Performs inventory reduction, routine to mid-level, (i.e. member inquiries, may adjust claims, responds to emails, etc.) May expedite, research, and resolve complex issues Consistently performs established performance metrics, such as quality, production; average handling time (AHT) and calls per hour (CPH) Works with minimal supervision
Successfully meets requirements of nesting audit Have strong customer service experience (especially phones) and a proven ability to meet performance standards Strong organizational skills Ability to work independently Ability to mentor others Ability to interpret the various health plans and any documentation associated with them
Minimum Experience Level
Typically 1-2 years of related experience successfully demonstrating increasingly higher level work